Rare Disease Report

Screening for Nasopharyngeal Cancer Using Epstein-Barr virus DNA

AUGUST 10, 2017
James Radke
Nasopharyngeal cancer is a rare head and neck cancer. In the United States, approximately 3200 new cases of nasopharyngeal cancer will occur each year.
The cause of the condition is unknown, but it has been previously linked to the Epstein-Barr virus. While patients with Epstein-Barr will likely not acquire nasopharyngeal cancer, those with the cancer have a history of the virus.
Due to the correlation, screening for the cancer can be done by first testing for the the virus. In the United States, due to the rarity of the cancer, such screening is not performed, however, in China, where nasopharyngeal is more common, clinicians may screen for it when testing for the virus.
A new study in the New England Journal of Medicine by Chan et al examined the use of Epstein-Bar virus screening to detect nasopharyngeal cancer in Chinese participants and concluded that the screening method is a useful tool. More specifically, 20,174 participants underwent screening for Epstein-Barr virus DNA and it was detected initially in 112 participants.
Subsequent testing found the virus DNA to be persistent in 309 people, and of the 309, most underwent endoscopic examination and magnetic resonance imaging (MRI). 34 people were diagnosed with nasopharyngeal cancer.
Compared to a historical cohort, there was a significantly higher proportion of people with early stage nasopharyngeal carcinoma using the virus screening method (viral screen vs controls: 71% vs. 20%, P < .001) and had superior 3-year progression-free survival (97% vs. 70%; hazard ratio, 0.10; 95% confidence interval, 0.05 to 0.18).

Table: Stage Distribution of Patients with Nasopharyngeal Cancer
 Stage Patients Identified by Screening Patients in Hong Kong, 2013



Within a year of testing, nasopharyngeal carcinoma developed in only 1 participant who tested negative for the Epstein-Barr virus DNA.
The study determined that the sensitivity and specificity of Epstein-Barr virus DNA screening for nasopharyngeal carcinoma were 97.1% and 98.6%, respectively.
The authors concluded that analysis of Epstein-Barr virus DNA in plasma samples is a useful screening tool for early asymptomatic nasopharyngeal carcinoma.
Chan KCA, Woo JKS, King A, et al. Analysis of Plasma Epstein–Barr Virus DNA to Screen for Nasopharyngeal Cancer N Engl J Med 2017; 377:513-522. DOI: 10.1056/NEJMoa1701717

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